MEDICARE: JIM TEHRANI DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	44547	CA

General Provider Information

NPI Number	:	1679608707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIM TEHRANI DDS

Provider Business Mailing Address
First Line	:	400 S SEPULVEDA BLVD
Second Line	:	SUITE 280
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6814
Country	:	US
Telephone Number	:	310-406-0745
Fax Number	:	310-406-1256

Provider Business Practice Location Address
First Line	:	400 S SEPULVEDA BLVD
Second Line	:	SUITE 280
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-6814
Country	:	US
Telephone Number	:	310-406-0745
Fax Number	:	310-406-1256

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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